Provider Demographics
NPI:1821124066
Name:RODGERS, RICHARD L II (DC)
Entity Type:Individual
Prefix:DR
First Name:RICHARD
Middle Name:L
Last Name:RODGERS
Suffix:II
Gender:M
Credentials:DC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4221 E WINDSONG DR
Mailing Address - Street 2:
Mailing Address - City:PHOENIX
Mailing Address - State:AZ
Mailing Address - Zip Code:85048-0546
Mailing Address - Country:US
Mailing Address - Phone:808-927-7951
Mailing Address - Fax:
Practice Address - Street 1:2373 E BASELINE RD
Practice Address - Street 2:SUITE 102
Practice Address - City:GILBERT
Practice Address - State:AZ
Practice Address - Zip Code:85234-2477
Practice Address - Country:US
Practice Address - Phone:808-927-7951
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-02-24
Last Update Date:2016-01-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH2911111N00000X
HI1181111N00000X
AZ8334111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH2194549Medicaid
OHDD7573Medicare PIN
RO4023114Medicare PIN
OHU82375Medicare UPIN
OH4023113Medicare PIN